Hunter-Ear Infections Flashcards
1
Q
What is otitis externa?
How often does it occur?
Who most commonly gets it?
What are the predisposing factors of otits externa?
A
- externa auditory canal infection (swimmer’s ear)
- 4 of every 100 persons each year
- swimmers and divers
- high enviromental temp, trauma from mechanical removal of cerumen or following insertion of foreign objects, and chronic dermatologic disease (eczema)
2
Q
(blank) are the most common causes of otitis externa. Which one in particular?
What is a less common cause of otitis externa?
A
Gram-negative bacilli
- Pseudomona aeruginosa (most common cause of swimmers ear and malignant otitis externa)
- Staph aureus
3
Q
How can otitis externa present with?
Whats it caused by?
A
- ear pain, itching, discharge, external canal red and swollen
- tender pinna
- chewing is painful
- low fever (below 38 C)
Pseudomonas Aeurginosa!!!! (sounds like Sea monster and you get it when you swimming :)
4
Q
How do you treat otitis externa?
A
Dicloxacillin or ciprofloxacin
less severe use ofloxain ear drops
5
Q
What are the clinical symptoms of MALIGNANT otitis externa?
What is it caused by
How do you treat it?
Is this fatal?
A
- high temp (greater than 38.3 C)
- otorrhea (discharge)
- necrotizing infection (can attack mastoid process of bone, can go to brain etc)
- Pseudomonas Aeurginosa
- Imepenem
- if untreated, YES!
6
Q
What is otitis media?
A
a bacterial infection of inner ear mucosa with exudate production seen in children
7
Q
(blank) percent of children experience an episode of otitis media before 1 year of age. (blank) percent by the age of 3
A
50%
80%
8
Q
What is the most frequent diagnosis in febrile children? Which gender is more affected?
A
Acute otitis mdia
Boys more often than girls
9
Q
Infants and children with what 2 things should be examined to determine if they have otitis media?
Why?
A
purulent conjunctivitis
rhinosinusitis
Because the same organisms attack these and you have eustachian tube linking these
10
Q
Who will get recurrent otitis media?
A
immune deficient persons
11
Q
What are the most common causes of acute otitis media?
A
- Streptococcus pneumoniae,
- Nontypeable Haemophilus influenzae
- Moraxella catarrhalis
Less commonly staph aureus and strep pyogenes
12
Q
In children younger than 6 weeks of age, (Blank) are the culprit of acute otitis media
A
gram-neg bacilli
(e.g., Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeurginosa) Commonly cause acute otitis media
13
Q
What is acute otitis media usually preceded by?
A
upper respiratory tract viral infection
14
Q
How can you get a serous effusion in acute otitis media?
How will an effusion present?
A
a blocked eustachian tube prevents mucosal absorption of air, causing negative pressure in the middle ear and production of a serous effusion
Tympanic membrane bulge
15
Q
What are the definitive symptoms of acute otitis media?
How do you treat it?
A
Pain, fever, midle ear effusion
-analgesic (acetaminophen) if pnt remains symptomatic by day 3 give antibiotic amoxicillin
16
Q
(blank) are relatively common and appear as acute purulent papules that occur at the lid margin. What are they caused by?
A
Hordeola (styes)
-Staph aureus (90-95% cases)
OR can be caused by blepharitis (blockage and infection of the Zeiss or Moll sebaceous glands or meibomian glands in the tarsal plate)
17
Q
So which glands can be blocked and cause hordeola (styles)
A
- Zeiss
- Moll
- Meibomian
18
Q
What are the granulomatous lesions seen in styes?
How do you treat styes?
A
chalazia
-give warm compress and should drain spontaneously,
IF external-> the lesions can be drained by lancing or by epilating nearby lashes.
IF internal-> give warm compress plus oral dicloxacillin (for methicillin sensitive staph)
-good hygiene
19
Q
Who should be suspected of having orbital cellulitis?
A
pnts w/ recent sinusitis, facial trauma, or surgery or dental work
20
Q
Where do most cases of orbital cellulitis result from?
What is the most likely pathogen?
How do you treat it?
A
ethmoid sinusitis
- strep pneumo and other strep
- staph aureus
- H. influenza
-nafcillin, ceftriaxone, and metronidazole
21
Q
In 10% of cases of orbital cellulitis can result in some (Blank) loss. What are some other serious complications of orbital cellulitis?
So you must be able to distinguish this from the less serious (Blank).
A
vision loss
- brain abscesses, meningitis, cavernous venous thrombosis
- Preseptal (periorbital) cellulitis
22
Q
What are common findings of orbital cellulitis?
A
Proptosis (abnormal protrustion of eye)
Opthalmoplegia (paralysis of muscles within or surrounding the eye)
Chemosis (eye irritation)
Fever, headache, malaise.
23
Q
What is conjuctivitis?
A
Inflammation of the palpebral and bulbar conjunctiva
24
Q
Most organisms that cause conjunctivitis also cause (blank).
Is it common?
What age does this occur in?
What is a common name for this disease and what is it caused by?
A
keratitis (keratoconjunctivitis)
yes
All ages
A common name for this disease, pinkeye, caused by inflammatory blood vessel dilatation
25
What is the etiology of viral conjunctivitis?
Adenoviruses -> most common viral cuase (HSV-1 and HV-2 are less common but can cause a more serious keratitis)
26
What is the etiology of purulent conjunctivitis?
- Staph aureus, -Strep pneumonia
- H. influenza
- Moraxella catarrhalis
27
What causes hyperpurulent conjunctivitis?
Neisseria gonorrhorea (can cause signficant corneal damage)
28
What causes follicular (inclusion) conjunctivitis in sexually active teenagers and young adults?
What else does this cause?
Chlamydia trachomatis
Trachoma-Leading cause of infectious blindness in the world
29
(blank) and (blank) can cause conjunctivitis in newborns (opthalmia neonatorum), which can spread from conjunctiva and rapidly infect the cornea
N. gonorrhoeae
| C. trachomatis
30
What is the pathogenesis of conjunctivitis?
infectious agents adhere to the conjunctiva and overwhelm normal defense mechanisms (e.g tearing, lysozyme) resulting in redness, discharge, and irritation
31
Conjunctivitis usually is a (blank) process; however, in immunocompromised patients and in patients with certain infectious agents, conjunctivitis can cause serious infections of the cornea that threaten loss of sight
self-limited
32
(blank) caused by N. gonorrhoeae acquired in the birth canal can be invasive and can lead to rapid corneal perforation
Ophthalmia neonatorum
33
(blank) can lead to conjunctival scarring (particularly in trachoma (eyelashes bent inward toward your eyes)
Chlamydial conjunctivitis
34
Viruses and Chlamydia can cause the lymphatic tissue in the conjunctiva to hypertrophy, resulting in (blank)
follicle formation (follicular conjunctivitis)
35
What is this:
| kid swimming in pool, has gritty feeling in eye, with excessive tearing.
Viral conjunctivitis
36
Why does the sclera appear red in viral conjunctivitis?
conjunctival blood vessels dilate and underlying white sclera appears red
37
If you have conjunctivitis with a purulent discharge, what caused this?
bacteria
38
Is vision typically impaired in viral conjunctivitis?
no (cornea and pupil appear normal)
39
How do you treat viral conjunctivitis?
supportive (artifical tears and cold compress)
| IF herpes use acyclovir
40
What is this:
| baby with a fever, eyes are erythematous and draining purulent material. Neisseria is cultured from exudate
Opthalmia neonatorum
41
Neisseria gonorrhoeae occurs within (blank) days of delivery, compared to (blank) days for the more common Chlamydia trachomatis
2 or 3
| 4-10
42
Untreated Neisseria kerato-conjunctivitis can progress to ulceration or perforation of the cornea in (blank) hours
24 hr
43
In actively infected mothers, there is a (blank) vertical transmission rate during vaginal delivery
30-50%
44
How do you treat opthalmia neonatorium caused by neisseria?
Ceftriaxone is effective in treating neisserial infections in the newborn; erythromycin ointment use for prophylaxis
45
What is this:
10 year old presents from columbia with purulent eye discharge and swollen eyelides and trichiasis (turned in eyelashess), preauricular lymphadenopathy and light sensitivity. THere is follicular inflammation. She was living in a place of poor sanitation.
Trachoma caused by chlamydia trachomatis
46
(blank) is a disease of poverty and unsanitray living conditions. Presents as a mucopurulent keratoconjunctivits. The conjuctival surface of upper eyelid shows follicular response. Triachiasis is present
Trachoma
47
Why can trachoma lead to blindness?
the trichiasis causes an intensely irritating foreign body sensation and corneal scarring. The corneal scarring or cicatricial can lead to blindness
48
Inflammation of the cornea is referred to as (blanK). Most cases of keratitis also involve the (blank).
keratitis
conjunctiva leading to keratoconjunctivitis
49
Microbial keratitis is a potentially (blank) condition that can be caused by many different viruses, bacteria, fungi, or parasites
vision-threatening
50
(blank) are the most common risk factor for microbial keratitis diagnosed in the US
Contact lenses
51
What are the most common causes of viral keratitis?
HERPES SIMPLEX (type 1 adults, type 2, neonates)
Varicella zoster
Adenoviruses
52
What are the most common causes of bacterial keratitis?
STAPH AUREUS
Strep pneumoniae
S. pyogenes
H. Influenzae
53
What are the most common causes of fungal keratitis?
Aspergillus
Fusarium
Candida
54
What 2 pathogens cause keratitis in contact lens wearers?
Acanthamoeba (protozoan)
| Pseudomans auerginosa
55
What is this
young sexual activity female with medical history for HSV presents with photophobia, right eye pain and decreased vision.
HSV keratitis
56
What is the most common corneal infection in the US? What is the leading cause of INFECTIOUS blindness and need for corneal transplantation?
Are they usually bilateral or unilateral?
HSV keratitis
HSV Keratitis
Unilateral (90%)
57
How does HSV get transferred to eye?
Can be transferred to eye from oral or genital herpes lesions. Can also spread from trigeminal ganglion
58
HSV infection may progress from epithlieum to more damaging (blank) involvement
stroma
59
How do you treat HSV keratitis?
Trifluridine drops for 3 weeks
If infection persists, add acyclovir
Use corticosteroids too!
60
What is the uvea?
the pigmented, vascular middle layer of the eye b/w the cornea-sclera outer protective layer and the retina
61
What is inflammation of the uvea?
| What is it caused by?
uveitis
| -autoimmune conditions, infections, or trauma. 50% of cases are idiopathic
62
Infections caused about (bank) percent of all uveitis cases, with the most common infectious etiologies being (blank) and (blank)
infectious
| Herpetic infections and toxoplasmosis
63
(blank) presents with eye pain, decreased vision, ciliary flush, and cells in the anterior chamber (hypopyon). The vitreous has few cells and the retina is normal.
Anterior uveitis
64
(bank) presents with painless loss of vision, few cells in the anterior chamber, many cells in the vitreous, and lesions in the retina, choroid, or both
Posterior uveitis
65
(blank) refers to bacterial or fungal infection of the vitrious or aqeous humor or both. Most cases are exogenous; organisms are introduced from an external source (e.g cataract surgery)
Endophthalmitis
66
What causes anterior uveitis (iritis, cyclitis, iridocyclitis)?
Herpes simplex
67
What causes posterior uveitis (choroiditis, chorioretinitis, retinitis)?
Toxoplasma gondii
CMV
Toxocara canis
68
What causes panuveitis (all uveal structures)?
Treponema pallidum
69
What causes Endopthalmitis (Endophthalmitis is an inflammatory condition of the intraocular cavities (ie, the aqueous and/or vitreous humor) usually caused by infection)?
- Staphylococcus aureus
- Streptococci
- Gram-negative bacilli
70
What is this:
older man presents iwth blurred central vision in right eye for 2 weeks. Is visual acuity is lessened, and fundus exam showed whitish-yellowins inflammatory lesion near an atrophic pigmented retinochoroidal scar. Serum IgG to toxoplasma is elevated
Toxoplasma chorioretinitis
71
What is the most common cause of posterior uveitis in otherwise healthy individuals (worldwide)?
Toxopasma chorioretinitis
72
An active, unifocal area of acute chorioretinal inflammation adjacent to an old (blank) suggest toxoplasma chorioretinitis
Chorioretinal scar
73
In toxoplasma chorioretinitis, (Blank) inflammation can be severe. Some damage is due to (blank) immunopathology
- Vitreous
| - T cell mediated immunopathology
74
In toxoplasma chorioretinitis, what happens if you have bradyzoites (cysts) in the eye? Vision may be impaired when?
Can pregnant females pass this one?
Many cases of toxoplasma chorioretinitis originate as (blank) infections.
they can reactivate
- when lesions form in critical locations (macula)
- yes, 1/3rd do during pregnancy
- congenital infections
75
What countries do you find the common cold?
What season is it seen most commonly?
A child less than 5 years develop this (blank) times a year?
Adults?
90% are caused by (blank)
How is it spread?
```
World-wide
Winter
5-7/year
1-2/year
viruses
person to person
```
76
What are the viral causes of cold?
RHINOVIRUS>Coronaviruses>adenoviruses, myxoviruses, enteroviruses
77
What is the pathogenesis of common cold?
Rhinovirus enters nasal passage-> virus infects ciliated COLUMNAR epithelial cells (binds ICAM-2)-> host cells killed causing inflammation (hyperemia and edema)
78
What are the clinical findings of a cold?
Clear, mucoid nasal secretions (rhinorrhea) intially produced, can become mucopurulent with secondary bacterial infection with normal flora.
79
What happens if yor cold results in severe blockage of sinus ostia or the eustachian tube?
What also can a cold progress to?
- paranasal sinusitis or otitis media
| - to lower respiratory tract and cause bronchitis
80
What is this:
A 24-year-old woman comes to the clinic with complaints of a runny nose, congestion, sore throat, myalgia, and headache of 5 days duration. Physical examination reveals erythematous nasal passages with clear mucus draining from the patient’s nose. A few small nasal polyps are seen. No pain on palpation of the sinuses is noted. Her vital signs are temperature 38.5°C, pulse 73/min, blood pressure 120/85 mm Hg, and respirations 18/min.
common cold
81
How do you diagnose cold? how do you treat it?
clinically-> symptoms, localization, time of year
| -Tx: supportie therapy handwashing, disinfecting stuff
82
What is this:
inflammation or infection of nasal passage mucosa and at least one of the paransal sinuses that lasts no longer than 4 weeks
acute rhinosinusitis
83
(blank) cause most cases of acute rhiniosinusitis (more than 32 million people a year). Do you neeed to treat them?
Sinuse infections may follow (blank X 3)
Infections occur most often during (blank) months.
- respiratory viruses
- NO
- common cold, dental extractions, rhinitis due to allergies
- winter months (when colds are most common)
84
Most cases of acute rhinosinusitis are due to respiratory viruses, which include (blank X 4)
- rhinovirus
- parainfluenza virus
- respiratory syncytial virus
- adenovirus
85
Acute viral rhinosinusitis can be complicated by a bacterial infection and is diagnosed as (blank)
acute bacterial rhinosinusitis
86
The most common causes of acute bacterial rhinosinusitis?
- Streptococcus pneumoniae
- nontypeable Haemophilus influenzae
- Moraxella catarrhalis
87
Immunocompromised patients are also prone to fungal rhinosinusitis due to (blank x 3)
Mucor, Rhizopus, Aspergillus
88
What is this:
A 5-year-old boy was taken to the pediatrician because of fever and runny nose. His parents mentioned that he had a cold about 2 weeks ago. Other than the runny nose, he seemed to be fine until about 2 days ago when he developed a high fever and complained of pain just below his right eye. His vital signs are temperature 39.5°C, pulse 110/min, blood pressure 110/80 mm Hg, and respirations 21/min. Physical examination reveals pain when pressure is applied over the left maxillary sinus. Frontal X-ray shows maxillary sinus congestion (A). The nasal passages are both inflamed. The right nasal passage contains purulent material that is draining from a partially blocked nasal ostium. Gram stain of exudate showed Streptococcus pneumoniae
Acute bacterial rhinosinusitis
89
How do you diagnosis bacterial rhinosinusitis?
What are the symptoms of this?
What is it often preceded by?
What makes the rhinosinusitis more likely a bacterial infection than a viral?
What happens if you have obstruction of the paransal sinus ostia due to this?
clinical signs and symptoms
- sneezing, RHINORRHEA, nasal congestion, postnasal drop, aural fullness, FACIAL PRESSURE, headache, sore throat, cough, fever, myalgias
- viral upper respiratory tract infection
- high fever (>39 C) and purulent discharge
impedes drainage of mucus secretions; bacteria grow in these secretions
90
How do you treat acute viral rhinosinusitis?
Symptomatic TX
- oral hydration: nasal saline and steam promote to drainage
- Antipyretics, analgesics (e.g acetaminophen), and decongestants (e.g oxymetazoline)
91
How do you treat antibiotic tx (acute bacterial rhinosinusitis)?
Initial antibiotic therapy with amoxicillin or cefdinir (trimethoprim-sulfamethoxazole or azithromycin in beta-lactam allergic patients)
- have septal deviations, large nasal polyps, or foreing bodies surgically removed
- practice proper dental management
92
What is this:
A 67-year-old woman presented to the emergency department (ED) with delirium resulting from diabetic ketoacidosis. She also complained of headache, facial pain, nasal congestion, left eye pain, and blurry vision of 2 weeks’ duration. She noted recent bloody nasal discharge and confusion, which was her reason to come to the ED. The patient’s past medical history was significant for poorly controlled type 2 diabetes mellitus. Vital signs were: temperature, 36.7°C (98°F); pulse, 114 beats/min; respiratory rate, 25 breaths/min; blood pressure, 116/20 mm Hg; oxygen saturation, 98% on room air. She had a black eschar on the roof of her mouth, and histopathology of the sinuses revealed broad-based, irregular, ribbon-like, nonseptate hyphae with right angle branching (A).
Acute Rhinocerebral mucormycosis (mucor or rhizopus)
93
What is the most common presentation of rhinocerebral
mucormycosis?
What is an important risk factor for this?
What can yield a diagnosis?
What can this rapidly progress to?
- facial pain, headache, lethargy, visual loss, proptosis, and/or palatal ulcer (eschar)
- Diabetes
- fine-needle aspiration (silver stain shows nonseptate hyphae and right angle branching)
CNS involvement (cavernous venous thrombosis) and death
94
How should you treat rhinocerebral mucormycosis (mucor or rhizopus)?
Liposomal Amphoterocin B
OR surgical consult for extensive debridement of all infected and necrotic tissue, with drainage of all sinus and abscess fluid collections
95
What is the distribution of pharyngitis?
| When is it most common?
- world-wide (>15 million physician office visits each year in the US)
- during winter and early spring
96
What are most cases of pharyngitis caused by?
viruses
97
Who will get pharyngitis due to Streptococcus pyogenes (strep throat)?
children age 5-15 years
98
With few exceptions (i.e. diptheria), pharyngitis is (blank).
How is it acquired?
- benign and self-limiting
| - person to person contact following contaminated fomites
99
What is the most common cause of unnecessary use of antibiotics?
pharyngitis
100
Viruses are the most common cause of pharyngitis, What are the viruses that do this?
```
RHINOVIRUS
ADENOVIRUS
EBV
CMV
HSV
Influenza
Parainfluenza
Coronavirus
Enterovirus
HIV
```
101
(blank) is the most common bacterial cause of acute pharyngitis
Strep pyogenes
102
(blank) causes a serious pharyngitis with systemic complications
Cornybacterium diptheriae
103
(blank) can cause a fungal oropharyngitis called thrush. Who is this most often seen in?
Candida albicans
| Immunocompromised pnts
104
In viral pharyngitis, what is the pathogenesis?
Viruses gain access to mucosal cells lining nasopharynx and replicate and damage them
105
In bacterial pharyngitis, what is the pathogenesis?
| What are the extracellular factors produced by this pathogen?
S. pyogenes attaches to the mucosal epithelial cells using M protein
S. pyogenes produce protease and hyaluronidase to assist bacteria in invading mucosa
106
(blank) can occur after an episode of strep induced pharyngitis
Rheumatic fever
107
What are the common findings in S. pyogenes pharyngitis?
- fever
- severe pain upon swallowing
- headache, nausea, vomiting, abdominal pain
- tonsillopharyngeal erythema
- LYMPHADENITIS (cervical)
108
What can untreated S. pyogenes pharyngitis patients develop?
How do you treat S. pyogenes pharyngitis?
- Rheumatic fever, peritonsillar abscess, cervical lymphadenitis, mastoiditis
- oral penicillin V for 10 days
109
If your patient has pharyngitis what test should you perform?
- throat culture (to determine bacterial and not viral)
- if throat culture says its strep pyogenes then you must treat with antibiotics.
- Do a rapid test, if positve for strep A then treat, if negative, wait for throat cultures before treating because throat cultures are more sensitive
110
What kind of agar should you use to test for strep pyogenes?
blood agar
111
What is this:
A 32-year-old woman saw her physician because of complaints of soreness in her mouth that started about 1 month ago. She has been taking systemic corticosteroids for asthma. Lymphadenopathy of the cervical lymph nodes is observed. Her pharynx appears similar to that shown in the figure below (A). A sample of the material obtained from the patient’s pharynx was sent to the laboratory for culture and Gram stain. The material grew as creamy white colonies on Sabouraud dextrose agar with chloramphenicol. What organism caused this?
Oropharyngeal candidias (thrush)
-Candida albicans (the most commonly implicated organism in this condition)
112
What are the clinical findings of oropharyngeal candidiasis (thrush)?
How do you treat this?
- typically painles but may have burnign sensation when swallowing, occasionally some dysphagia
- Topical nystatin or Clortrimazole
- manage cause of immunosuppression
113
Where do you find diptheria?
worldwide but rarely seen in the US
114
Where does corynebacterium
| diphtheriae colonize?
the oropharynx and the skin.
| HUMANS are the only known resevoir
115
How do you transmit C. diptheriae?
respiratory droplets and by skin contact
| by healthy carriers, convalescent patients, patients incubating disease
116
What does diptheria look like?
"irregularly" stained gram-positive, club shaped bacteria
117
How do we get the diptheria toxin?
| How do you get damage to the pharynx?
- The diptheria toxin gene is encoded by a bacteriophage found in toxigenic strains, integrated into the bacterial chromosome
- Damage to the pharynx is caused by the diptheria toxin, which kills the mucosal cells
118
How does the diptheria toxin kill mucosa cells?
by ADP-ribosylation of elongation factor II and terminates protein synthesis
119
An inflammatory response to cell death and the dead cells form the pharyngeal (blank) found in diptheria. What else can the toxin bind to and damage?
Which is the major complication of this disease?
- pseudomembrane
- heart and nerve cells
- myocarditis (has a high mortality rate)
120
(blank) are most sensitive to the diptheria toxin, resulting in difficulty swallowing and in nasal regurgitation of liquids.
Cranial nerves
121
What is this:
An 8-year-old girl with no history of childhood immunizations presents with pharyngitis, a low-grade fever (38°C), and cough. Physical examination reveals a severely swollen and edematous neck region (A). Her cervical lymph nodes can be palpated and are also swollen. Her pharynx is erythematous, and it is painful for her to swallow. The gray material at the back of her throat caused some bleeding when removed for cultures (B). The patient also mentioned not being able to feel the roof of her mouth. Her breath has an unpleasant odor, and she has a dry cough. An inspiratory stridor is noted upon auscultation of the lungs.
Diphtheria
122
What does diptheria present with?
- pharyngeal pain, pseudomembrane on the tonsils and back of the oropharynx
- regional lymphadenopathy ("bull neck"), edema of the surrounding tissues, fetid breath, low-grade fever, and cough are also common.
- Airway obstruction can occur, and findings of tachypnea, stridor and cyanosis are seen
123
The diptheria toxin can damage the heart and the cranial nerves, causing (blank) and (Blank).
How do you test for diptheria?
myocarditis
neurologic abnormalities (e.g. palantine palsy, difficulty swallowing, nasal regurgitation of liquids)
-swab the oropharynx and use the Elek immunodiffusion assay
124
How do you treat and prevent diptheria?
- hospitalize and place in isolation
- Give antiserum to neutralize the diptheria
- Second most urgent task is antimicrobial tx with erythromycin or clindamycin
- diptheria vaccine
125
What diptheria vaccine do you give to adults?
| To children?
- DT vaccine for adults
| - DTaP vaccine for children
126
What are the three acute inflammatory diseases of the upper airways?
What is the most common and most serious risk of this group of diseases? Why is this risk so serious in young children?
Croup
Laryngitis
Epiglottis
- Airway obstruction
- Because airways of young chilren are narrower than the airways of older children and adults
127
What are the most common causes of croup?
Viruses-> most importantly parainfluenza viruses (most prevalent)
128
A variety of microorganisms are associated with acute laryngitis such as.....?
- rhinovirus
- adenovirus
- coronarvirus
- metapneumovirus
- influenza virus
- myocplasma pnemoniae
- Chlamydophila pneumonia
129
Epiglottitis is caused by many microorganisms as well, but predominantly (blank)
H. influenzae type b
130
What do viral infections of the upper airway cause in the larynx?
inflammation and edema of the larynx in acute laryngitis
131
Viral infections in the larynx, trachea and bronchi causes (blank)
viral croup
132
(blank) is produced by the host and causes partial obstruction of the airway in both acute laryngitis and viral croup
Mucus
133
What does acute paryngitis present with?
-swelling of the vocal cords that results in dysphonia (hoarseness), odynophonia (pain when speaking) and dysphagia (difficult swallowing)
134
In viral croup what are the 2 distinct sounds heard and why?
Stridor: narrowing of the subglottic trachea
| Barking cough: occurs in pnts with viral croup caused by laryngotracheal inflammation
135
Epiglottitis is a (Blank) of the epiglottis and the surrounding tissues. What does H influenza type b. do in epiglottitis? Then what happens?
cellulitis
- organisms then grow in the tissues and cause an inflammatory response that results in erythema and edema
- a sore throat rapidly progresses to difficulty breathing, stridor, and obstruction of the airways that may lead to respiratory arrest
136
What is this:
A previously healthy 3-year-old boy presents to the emergency department with fever, stridor, and hoarseness. His mother reports that he has had a runny nose and mild cough for the past week. Overnight, she noted his cough had worsened and sounded like “barking” (A). On examination, he has a temperature of 38.2° C (100.8° F), heart rate of 95/min, respiratory rate of 20/min, and pulse oximetry of 97% on room air. Pulmonary exam is significant for tachypnea and inspiratory stridor; mild retractions and nasal flaring are noted. Cardiac exam is unremarkable. Anteroposterior x-ray of the neck demonstrates subglottic narrowing consistent with a “steeple sign”
Croup
137
How does croup begin?
Prodromal mild upper respiratory infection with coryza, nasal congestions, sore throat, and cough that lasts 2-3
138
How is croup clinically diagnosed?
based on fever, stridor, and the characteristic barking cough AND
a steeple sign on x-ray (narrowing of the trachea)
139
(Blank) vaccine has significantly reduced the incidence of epiglottitis to <0.7 cases per 100,000 persons
H. influenzae type b (Hib)
***NOTE: H. influenzae type b is still most common cause of epiglottitis*****
140
The prevalence of epiglottitis in (blank) now surpasses the prevalence in (blank), which is due to the success of Hib vaccination of children
adults
| children
141
T or F
| the morbidity and mortality of epiglottitis can be very high
T
| REMEMBER this is how george washington died
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What is this:
A 2-year-old previously healthy girl presents to the emergency department with a 2-h history of difficulty breathing. Immediate intubation is required. The child appears toxic, acutely distressed, and has a fever of 39.5° C. She is drooling and her parents say she has had difficulty swallowing. Parents deny a barking cough. A swollen, erythematous, cherry red epiglottis can be seen during careful examination of the oropharynx
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Bacterial epiglottis
(caused by H. influenza type b)
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143
What is the main priorty in epiglottitis?
| What should you do if its a child?
- securing and maintaining the airway is the overiding priority
- be in a pediatric ICU
144
What is the usually the first symptom of acute bacterial epiglottis?
What is the clinical triad seen in bacterial epiglotitis?
What will neck radiograph reveal?
How do you treat this?
- fever, with temps reaching 40 C
- Drooling, dysphagia, distress (classical presentation)
- thumbprint sign
- ceftriazone or cefotaxime for 7-10 days; corticosteroids
145
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What causes pertussis (whooping cough)?
Where do you find it?
How do you lower the US incidence?
What is the natural host of pertussis?
How does the disease get transmitted?
When is it most serious?
What could 50% of cases of children with pertussis be traced to?
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- Bordetella pertussis (gram-negative coccobacillus)
- world-wide (> 1 million deaths a year, most in underdeveloped countries)
- pertussis vaccine (DTaP)
- HUMANS ONLY!
- person to person via aerosolized droplets; highly infectious
- in children less than 12 months of age
- adults with chronic cough (carriers)
146
B. pertussis is inhaled in (blank) and attaches to the (Blank) in the trachea.
respiratory droplets
| ciliated epithelium
147
What components of pertussis causes the tissue damage in the trachea?
Pertussis toxin
Tracheal cytotoxi
Filamentous hemagglutinin
148
Why do patients cough wih pertussis? What are the neurological effects of pertussis caused by?
- because large amounts of mucus are produced in response to the infection and cause the patient to cough
- associated hypoxia and intracerebral hemorrhage
149
What is this:
A 1-year-old girl is brought to the emergency department because of a fever and worsening cough for the past week. She is sneezing. Her vital signs are temperature 38.9°C, pulse 130/min, blood pressure 130/90 mm Hg, and respirations 27/min. Mother says that the child sometimes turns “blue” when coughing and yesterday fainted following a particularly severe episode. A physical examination reveals a very ill and distressed child. A coughing episode began in the emergency department and lasted for about 30 seconds. The coughing was short and rapid and ended with a high pitched sound associated with inhalation. Significant inspiratory stridor was noted. The child has no history of immunization. A complete blood count reveals a significant lymphocytosis.
Pertussis
150
What can pertussis begin with?
What is the paroxysmal phase like?
How does the cough begin?
- catarrhal phase (mucous membrane inflammation, looks like upper respiratory tract infection)
- sudden episodic coughing and generally lasts 2-4 weeks (average of 15 attacks per 24 hr)
- with an inspiratory "whoop" that is pathognomonic
151
What do severe cases of pertussis result in?
Hemoptysis, subconjunctival hemorrhages, hernias, seizures and death
152
How do you diagnose pertussis and how do you treat it?
- culture aspirates on bordeta- Gengou medium and serology.
- elevated WBC with a lymphocytosis
-Erythromycin (but does little during paroxysmal phase)
